The Facility form is color coded, with green sections denoting data to be submitted by all participants and gold sections denoting data for Gold Level participants. If your facility participates at the Gold Level then at least one field shown in gold must be entered.


The Facility form must be completed upon initial registration and at the beginning of each subsequent calendar year.

Note: If both a Facility form and at least one Monthly form exist for the same year, then the Facility form cannot be cancelled. In this case, you must first cancel all monthly forms for the year, and then cancel the Facility form.


A printable version of the Facility form is available for your workflow processes and should not be submitted to the ACR.


Complete the form as follows; refer to the GRID Data Dictionary for more detailed information on each data element:

Field Name

Description

Facility Number

This field is filled in automatically, as determined by the user’s profile

Year

Enter the calendar year for which you will be entering data, other than data specifically requested for the previous year. For example, if you enter 2017 in this field, then you should complete Number of admissions, Number of radiography exams, and all other fields for which previous year data are requested, using 2016 data. All other fields, such as Case mix index and Number of FTE radiologists, should be completed using 2017 data.

Note: You cannot add a Facility form for the same year for which another form exists, even if it is cancelled. If you want to enter data for a year for which a cancelled form exists, you must restore the cancelled form and change the data to how it should appear on the new version of the form. (See Manual Data Entry for more information on restoring a form).

Setting

If your facility is a hospital, then enter data for Number of admissions during the previous calendar year and Case mix index. Otherwise, check Not applicable.

Volume

Enter the number of procedures of each type performed at your facility during the previous calendar year. If a procedure is not normally performed at your facility, check Not applicable.

Personnel

Enter the number of personnel of each type employed at your facility. This includes staff outside the radiology department (e.g. cardiac) and assistants that perform front-office functions in addition to technologist’s functions. You should keep this information up to date if it changes during the year. Choose the appropriate response for questions regarding certification requirements at your facility.

Note: The CT Certification or MRI Certification questions will be disabled if you checked Not applicable for those modalities in the Volume section.

MRI Incidents

Enter the number of incidents of each type that occurred at your facility during the previous calendar year. This section is disabled if you checked Not applicable for MRI in the Volume section, or if your facility is a Green Level participant.

Other Incidents

Enter the number of incidents of each type that occurred at your facility during the previous calendar year. This section is disabled if your facility is a Green Level participant.

Structural Measures

Choose the appropriate response for each question.

Note: Some choices are disabled, depending on whether you checked Not applicable for the corresponding procedures in the Volume section.

Protocol

Indicate whether a written protocol exists for each event or condition.

Equipment Type

Enter the number of ACR accredited units, the number of units pending ACR accreditation, and the total number of units at your facility for each equipment type.

Name of person who completed this paper form

If this name has not been previously entered for this field for a previous GRID form, then enter the person’s first and last name. In the future, the name will appear in the drop-down list for this field. If the name has been previously entered, click the arrow and select it from the drop-down list.



Note: Please populate this field even if paper forms were not used; you may use the name of the person completing the on-line data submission.

Name of person submitting form



Submission Date

These fields are filled in automatically.


Click the Submit button. You must correct any errors before the form will be accepted. If no errors are detected, a confirmation message appears and the form moves to Completed status.




Previous: GRID Data Submission Overview
Next: Manual Entry:
Monthly Data by Facility